September 19, 2017

Rehabilitation psychologists provide pathways to quality of life for the injured, ill

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traumatic injuriesMegan McMurray, Ph.D., left, and Casey Azuero, Ph.D.When a person experiences a traumatic injury or illness, much emphasis is placed on physical care and rehabilitation. But traumatic events, such as injury, chronic illness and other significant medical events, often have a major psychological impact on those affected.

While a person’s response to a traumatic event may vary, common responses include feelings of fear, grief and depression. These responses to trauma may last for weeks, months or even years before people begin to feel normal again, and personal illness or injury can significantly impact the lives of individuals and their families in many ways.

The University of Alabama at Birmingham’s Department of Physical Medicine and Rehabilitation and Spain Rehabilitation Center has been one of the Southeast’s foremost providers of comprehensive rehabilitation care since 1964. One important part of Spain Rehab’s comprehensive care team is rehab psychologists. Rehab psychology is a specialty area within psychology that focuses on the study and application of psychological knowledge and skills on behalf of individuals with disabilities and chronic health conditions in order to maximize health and welfare, independence and choice, functional abilities and social role participation across the lifespan.

Led by Amy Knight, Ph.D., the Physical Medicine and Rehabilitation Division’s director of Psychology, UAB’s team of rehab psychologists provides services to people experiencing a wide range of medical trauma, including fractures, burn, crush, amputations, spinal cord injury and mild to severe brain injury. Medical patients are also seen with conditions including peripheral weakness from infectious diseases, autoimmune disorders, cancer, cardiopulmonary conditions, postsurgical debility and neurodegenerative disease.

Knight says that, in order to understand what happens to a person psychologically after a traumatic event, one needs to understand that there are changes that occur in the brain. Traumatic stress can be associated with stress response areas in the brain, including the amygdala, hippocampus and prefrontal cortex.

McMurray says their ultimate goal is to help patients return to where they have a positive quality of life. The interdisciplinary team at Spain Rehab works to ensure patients and families know about the resources available to them following discharge.

Her team cares for patients who suffer from a wide variety of traumatic events, but says many experience similar hurdles on the road to recovery. Many of the common problems are fear or anxiety, re-experiencing the trauma — intrusive thoughts and images, flashbacks, or nightmares — irritability, avoidance or numbness, guilt, negative self-image, and others.

“We know the impact chronic stress takes on our bodies,” she said. “The overwhelming worry takes a huge a toll. It may be hard to see safety signals that allow relaxation, so patients remain continuously vigilant and prone to see threats that may not actually exist. There is potential for changes in brain connectivity, as if your brain gets rewired, after you go through a traumatic event or injury.”

The care patients receive at UAB is unique in that every patient will have an attending doctor and a resident, as well as occupational, physical and speech therapy, and dietary education if necessary.

Consider it interdisciplinary therapy.

UAB rehab psychologist Casey Azuero, Ph.D., says it is not just the patients who receive care. Families receive counseling and education as well.

“We don’t just consider patients; we consider families,” Azuero said. “We help the family cope. The role of family  after stroke or spinal cord injury can significantly change.”

Azuero says the support system around patients is a crucial part of the road to recovery, and it is a great predictor of better outcomes.

“Part of what we do is support their families, because that’s who they need,” Azuero said. “Another part of what we do is advocacy.”

That is why she and her colleagues coach and educate families on how to care for their loved ones. They provide assessments and gently guide families into a “new normal.”

However, Megan McMurray, Ph.D., another rehab psychologist, says not all support systems are created equal. Many people do not have family members or friends to assist them after they have been discharged.

“When you are ready to move on, where are you going to go next?” McMurray asked. “Social workers play a major role here. We work to get additional support around you if you don’t have that readily available. We want to be one of those pillars that helps support you.”

McMurray says their ultimate goal is to help patients return to where they have a positive quality of life. The interdisciplinary team at Spain Rehab works to ensure patients and families know about the resources available to them following discharge.

“We always ask ourselves, ‘what is the best quality of life that we can help facilitate so they can return to their regular activities?’” McMurray said.

To learn more, visit the Department of Physical Medicine and Rehabilitation website, or call the Psychology and Neuropsychology offices at 205-934-3454.

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